BACKGROUND: Immunoglobulin light chains are classified as middle molecule uremic toxins able to interact with B lymphocyte membranes leading to the activation of transmembrane signaling. The ensuing impairment of neutrophil function can contribute to the chronic inflammation state of uremic patients, and the increased risk of bacterial infections or vascular calcifications. The aim of this crossover observational study was to assess the difference in free light chain removal by three different hemodialysis filters in patients not affected by multiple myeloma...

A 75-year-old Japanese man presented with pruritic blisters and macules on his trunk and extremities. He had been on hemodialysis for 4 years because of chronic renal failure, and in recent months, a polymethylmethacrylate membrane had been used for dialysis. After a change in dialysis membrane to a cellulose triacetate membrane, pruritic tense blisters developed on the extremities in combination with marked blood eosinophilia. Physical examination showed erythematous macules and tense blisters on the trunk and extremities...

INTRODUCTION: Polymethylmethacrylate (PMMA) membranes can adsorb a wide variety of uremic toxins including serum free light chains (sFLC). However, limited data are available regarding the clinical use of PMMA in multiple myeloma patients and its maximum adsorption capacity in this setting. AIM: This study aimed to measure the capacity of PMMA to adsorb sFLC and identify strategies to improve its efficiency in clinical practice. METHODS: Ten patients with dialysis-dependent renal failure and high levels of sFLC were included in the study...

Prurigo nodularis is a skin disease with unknown origin which is frequent in patients on maintenance renal replacement therapy. Here, we report a patient who was dialyzed for more than 10 years with different dialyzers using different dialyzer membranes. Each time when the patient was switched to a polymethylmethacrylate membrane (Filtryzer BK-1.6P), itching and skin lesions disappeared completely. This effect could be verified three times.

AIM: Most chronic uremic patients undergoing dialysis show a diminished antibody response to anti-hepatitis B vaccination (anti-HBv) and at this regard high sCD40 serum levels seem to inhibit the immunocompetent response. A simple and feasible technique for removing soluble sCD40 by adsorption is standard bicarbonate dialysis performed by polymethylmethacrylate (PMMA) dialyzers able to remove serum high molecular weight toxins. Aim of the study was to assess whether PMMA dialyzers could enhance the long-term response to anti-HBv in non-responder (NR) ESRD patients...

The aim of this study was to investigate whether continuous hemodiafiltration (CHDF) with a high-performance membrane dialyzer made of polymethylmethacrylate (PMMA-CHDF) in the treatment of septic shock patients with acute renal failure (ARF) is clinically relevant. 30 patients were treated with PMMA-CHDF. 13 patients treated with CHDF used a hemofilter made of polyacrylonitrile membrane (PAN-CHDF). Systolic blood pressure significantly increased in the PMMA-CHDF group following 24 h of treatment (p < 0...

Sustained high-efficiency daily diafiltration using a mediator-adsorbing membrane (SHEDD-fA) is an effective, intensive modality for sepsis treatment. Here we describe the effectiveness of SHEDD-fA, which makes the best use of three principles: dialysis, filtration and adsorption, for mediator removal in the treatment of severe sepsis. SHEDD-fA was initiated after adequate fluid resuscitation and catecholamine support had been provided. A large (2.1 m(2)) polymethylmethacrylate membrane dialyzer was placed in the blood circuit...

Forty years have passed since the polymethylmethacrylate (PMMA) membrane was first developed. This article reviews its history and explains its longevity. The membrane was developed through application of a stereocomplex phenomenon that is observed upon mixture of isotactic and syndiotactic PMMA polymers. Filtryzer(TM) B1 and B2 were approved in Japan in 1977. B1 was the pioneer high-performance membrane model and B2 was a model that simulated a low-flux cellulosic membrane. The development of B1 led to the development of the dialysis machine with an ultrafiltration rate (UFR)-controlling function because the UFR of B1 was too high to control using transmembrane pressure control...

BACKGROUND: Following the introduction of modified cellulosic and then synthetic membrane dialyzers, it was realized that the dialyzer bio-incompatibility depends on the membrane composition. We designed a prospective, randomized, cohort study of 6 months to determine several parameters of biocompatibility in maintenance hemodialysis (MHD) patients treated with four different membrane dialyzers. METHODS: There were 60 MHD patients enrolled in the study. In baseline, synthetic low-flux dialyzer, polysulfone (PS) membrane was used in all patients for at least 3 months...

Selecting dialyzers is more important for blood purification in critical care because other therapeutic options (especially amount of dialysate) are usually limited. Adsorption is a major mechanism of removing toxic substances from patients in these treatments. Several commercial dialyzers designed for acute blood purification therapy were investigated by performing aqueous ultrafiltration experiments to demonstrate the adsorptive importance of membrane materials. Polymethylmethacrylate showed strong adsorptive characteristics to α-chymotripsinogen A (MW 25,000) but showed much less adsorptive characteristics to cytochrome C (MW 12,400)...

Commercial dialyzers were investigated both in vivo and in vitro for a better selection of dialyzers for hemodiafiltration (HDF) therapy. In in vivo online HDF, since a reduction rate of α(1)-microglobulin (α(1)-MG) was determined by the amount of albumin loss regardless of blood flow rate (Q(B)), ultrafiltration rate (Q(F)), and the performance of dialyzer, there is no preference for choice of dialyzers to remove α(1)-MG except for albumin sieving. It was clinically verified that albumin leakage mainly occurred in the first 60 min of treatment even in HD with a polysulfone dialyzer...

Since therapeutic conditions, especially the amount of dialysate, are usually limited in continuous renal replacement therapy (CRRT), selecting an appropriate membrane is more crucial than that in chronic hemodialysis. Under such circumstances, the use of a membrane with adsorption is expected to remove a larger amount of target substances in CRRT. Five commercial dialyzers were investigated to demonstrate the importance of membrane characteristics. The adsorptive characteristics of polymethylmethacrylate (PMMA) membrane were relatively low for cytochrome c (MW 12,400), very strong for alpha-chymotrypsinogen A (MW 25,000) and relatively strong for albumin (MW 66,000), which may be understood that the adsorption in PMMA has the optimal molecular size...

Polymethylmethacrylate (PMMA) membrane is the first synthetic polymeric hollow fiber used in dialyzers that is known to adsorb beta(2)-microglobulin. Polyester polymer alloy (PEPA), a blend of two polymers, i.e., polyarylate and polyethersulfone, is another dialysis membrane material with adsorption characteristics. In this study, the adsorption and permeation characteristics of BG-1.6PQ (PMMA) and FLX-15GW (PEPA) dialyzers were investigated by performing ultrafiltration experiments using chymotrypsinogen (molecular weight 25,000) and albumin (molecular weight 66,000) as test solutes...

Choosing dialyzers is more important in blood purification in critical care because therapeutic conditions (especially the amount of dialysate) are usually limited. Then, adsorption is the third major mechanism of removing toxic substances from patients in these treatments. Several commercial dialyzers designed for acute blood purification therapy were investigated by performing aqueous ultrafiltration experiments to demonstrate the importance of the membrane materials. Polymethylmethacrylate (PMMA) showed strong adsorptive characteristics to alpha-chymotripsinogen A (MW 25,000) but showed much less adsorptive characteristics to cytochrome C (MW 12,400)...

Alterations in plasma insulin and C-peptide concentrations following hemodialysis were evaluated using five types of dialyzer, which made of polysulphone, polyethersulfone, cellulose triacetate, polymethylmethacrylate, and polyester-polymer alloy, in diabetic patients. Plasma insulin and C-peptide were cleared by hemodialysis; their clearance rates and reduction rates differed across dialyzer types.

Uremic pruritus is one of the common complications in long-term dialysis patients. Recently, researchers reported that immunohypothesis with high serum level of cytokines could be the cause of uremic pruritus. Polymethylmethacrylate (PMMA) artificial kidney (AK) has been reported to adsorb more serum cytokines than other high-flux AKs. In July 2006, 30 patients with severe uremic pruritus from 300 chronic hemodialysis (HD) patients in a single center entered this prospective study. Their dialyzers were changed to PMMA AK for 4 weeks...

BACKGROUND: Advanced glycation end-products (AGEs) are now considered to contribute to the middle molecule toxicity of uremia and, because they are not cleared by conventional low-flux hemodialysis, alternative strategies are needed to improve their removal. METHODS: In a prospective cross-over trial involving 18 adult chronic hemodialysis subjects, we evaluated the intradialytic removal and the long-term effect on predialysis levels of Protein-bound (PBPe) and Free (FPe) pentosidine by high-pore, protein-leaking BK-F Polymethylmethacrylate-based hemodialysis (BK-F-HD), by comparing it to hemodialysis using low-flux dialyzers (LF-HD)...